July 11, 2007

American Wait Times

In his talk, __________ conceded that "the ___ healthcare system is not timely." He cited "recent statistics from the Institution of Healthcare Improvement… that people are waiting an average of about 70 days to try to see a provider. And in many circumstances people initially diagnosed with cancer are waiting over a month."

If you said "Troy Brennan, CEO of Aetna," and "United States," you'd be right! If you said Canada, or Britain, you'd be wrong. The article goes on:

A Commonwealth Fund study of six highly industrialized countries, the U.S., and five nations with national health systems, Britain, Germany, Australia, New Zealand, and Canada, found waiting times were worse in the U.S. than in all the other countries except Canada. And, most of the Canadian data so widely reported by the U.S. media is out of date, and misleading, according to PNHP and CNA/NNOC.

In Canada, there are no waits for emergency surgeries, and the median time for non-emergency elective surgery has been dropping as a result of public pressure and increased funding so that it is now equal to or better than the U.S. in most areas, the organizations say. Statistics Canada's latest figures show that median wait times for elective surgery in Canada is now three weeks.

"There are significant differences between the U.S. and Canada, too," said Burger. "In Canada, no one is denied care because of cost, because their treatment or test was not 'pre-approved' or because they have a pre-existing condition."

[B]oth data and anecdotes show that the American people are already waiting as long or longer than patients living with universal health-care systems. Take Susan M., a 54-year-old human resources executive in New York City. She faithfully makes an appointment for a mammogram every April, knowing the wait will be at least six weeks. She went in for her routine screening at the end of May, then had another because the first wasn't clear. That second X-ray showed an abnormality, and the doctor wanted to perform a needle biopsy, an outpatient procedure. His first available date: mid-August.

The article continues on" "If you find a suspicious-looking mole and want to see a dermatologist, you can expect an average wait of 38 days in the U.S., and up to 73 days if you live in Boston, according to researchers at the University of California at San Francisco who studied the matter. Got a knee injury? A 2004 survey by medical recruitment firm Merritt, Hawkins & Associates found the average time needed to see an orthopedic surgeon ranges from 8 days in Atlanta to 43 days in Los Angeles. Nationwide, the average is 17 days."

One important note on our system's wait times is that, unlike in other countries, we don't collect the data. "There is no systemized collection of data on wait times in the U.S," says Business Week. "That makes it difficult to draw comparisons with countries that have national health systems, where wait times are not only tracked but made public." That's a side benefit of the universal systems, which due to their coherence and incentives, are actually quite transparent. That allows not only for an accurate assessment of the problems, but the effective deployment of resources to treat them.

And by the way, want to know which country has the lowest wait times in international comparisons? Hint: It's where sauerkraut comes from.

Comments

Boy I can't wait to see the libertarian/right wing spin on this one. *Get's popcorn*

Posted by: phil | Jul 11, 2007 2:24:50 PM

Consistency doesn't seem to be a strong point among critics of the U.S. health care system.

Let's review. We are told both that:

"There is no systemized collection of data on wait times in the U.S. .... That makes it difficult to draw comparisons with countries that have national health systems, where wait times are not only tracked but made public"

And also that:

"A Commonwealth Fund study of six highly industrialized countries, the U.S., and five nations with national health systems, Britain, Germany, Australia, New Zealand, and Canada, found waiting times were worse in the U.S. than in all the other countries except Canada."

So which is it? We DO have reliable data on wait times in the U.S., and the Commonwealth Fund study used it to show that wait times are longer in the U.S.? Or we DON'T have reliable data, and the conclusions of the Commonwealth Fund study are therefore bogus?

Posted by: JasonR | Jul 11, 2007 2:30:13 PM

They won't spin it. They will simply deny results.

Posted by: akaison | Jul 11, 2007 2:30:16 PM

Brennan also recalled that he had formerly spent much of his time as an administrator and head of a physicians' organization trying "to find appointments for people with doctors.

Also worth noting. When you can open up a succesful business who's service is finding available appointments with doctors, you know you're country's healthcare system has waiting line problems.

Posted by: phil | Jul 11, 2007 2:30:36 PM

Oh- or do was Jason does- namely, try to throw in a bunch of red herrings and wait for the left to do its usual attempt to argue with his denials and red herrings. Meanwhile, by the end of it you are so tired and dejected you don't remember what the point was in the beginning.

Posted by: akaison | Jul 11, 2007 2:32:01 PM

by the way- I await the attempts and 50 responses later of watching people try to argue with Jason's logic.

Posted by: akaison | Jul 11, 2007 2:34:40 PM

Sigh. That's weak stuff Jason. In other countries, the government amasses data on all sorts of aspects of the health system, providing clear and continuous information on its workings. In our country, the best you can do are methodologically rigorous, but infrequent and narrowly-focused, studies conducted by private entities. It's not that there's no data, but that there's far less, and it doesn't exhibit trends nearly so effectively.

Errr, not to pick too much nit here, because it's a dandy post, but Brennan is CMO (chief medical officer) at Aetna. Ron Williams is the CEO. But good on him for coming clean.

U.S. wait times are definitely a bitch. My wife was going through menopause and had to wait four months for an appointment with a specialist after two other doctors (her OB/GYN and our family doctor) couldn't figure out how to control her night sweats and hot flashes. It ain't cancer, but it's still a pretty lousy thing to have to go through for that long.

And after our daughter was diagnosed with severe depression, it took nine weeks before she could get an appointment with a counselor (though the meds were prescribed very promptly, imagine that).

Posted by: Rick | Jul 11, 2007 3:16:28 PM

Sorry, Ezra, but you can't have it both ways. Either there's enough data to allow for a systematic, comprehensive comparison of waiting times between the United States and other countries, or there isn't. The Medical News Today article you linked to says there isn't. That means you cannot draw any meaningful conclusions about overall differences in waiting times from the Commonwealth Fund study.

But if you really believe that study is meaningful, here's another one, from the OECD in 2003. The OECD study found that waiting times are not a serious policy concern in the U.S., but are a serious concern in Australia, Canada, Denmark, Finland, Ireland, Italy, Netherlands, New Zealand, Norway, Spain, Sweden, and the United Kingdom. It also presents data showing much longer waits in other countries than in the United States for both routine health care services and serious ones, such as heart bypass surgery.

As for the claim that "most of the Canadian data so widely reported by the U.S. media is out of date," here is Statistics Canada's latest report on wait times in Canada. It found that median waiting times did not improve between 2003 and 2005, the latest year for which it reports data.

Posted by: JasonR | Jul 11, 2007 3:20:42 PM

Oh, and here's a report of an independent study of waiting times in Canada. It found that waiting times have gotten worse there since 1997. Quote:

Wait times for health care in Canada have increased significantly since 1997 when the average Canadian could expect to wait 11.9 weeks from the time of a referral from a General Practitioner to the time a specialist delivered the treatment required. In 2006, the average Canadian could expect to wait 17.8 weeks, nearly 50 per cent longer.

The increase in the total wait time for treatment was the result of a 72.5 per cent increase in the wait time to see a specialist after referral by a general practitioner and a 32.4 per cent increase in the wait time to receive treatment after an appointment with a specialist.

One of the most stunning examples of how additional funding has not resulted in better care is found in access to MRI and CT scanner technology. New investments were made in these technologies that increased their availability. But despite increased availability, Canadians did not experience shorter wait times for scans in 2006 than in 1997. The wait time for a CT scan increased from 4.1 weeks to 4.3 weeks between 1997 and 2006 while the wait time for an MRI scan went from 9.6 weeks in 1997 to 10.3 weeks in 2006.

Posted by: JasonR | Jul 11, 2007 3:33:54 PM

So if we do have wait times here. How are you going to make them go down by adding 45 million people to the system?

Posted by: Dingo | Jul 11, 2007 3:38:10 PM

I'm sure there's wait times with HMOs, since HMOs are just privately run, small single-payer organizations of a sort.

But in the US, if you have the money you can get anything you want done today.

As for the lowest wait times in Germany, I'll buy that. Also notice that Germany is a mix of public and private, with the option to self-insure on a cash basis even being available if you have the means.

So much for the virtues of single-payer.

Posted by: Adam Herman | Jul 11, 2007 3:41:27 PM

I agree a private/ public mix will be the only thing that flies here. No way will we want a system that Donovan McNabb has to wait 10 months behind Wally from the YMCA to get his knee fixed.

Posted by: dingo | Jul 11, 2007 3:47:58 PM

But if you really believe that study is meaningful, here's another one, from the OECD in 2003. The OECD study found that waiting times are not a serious policy concern in the U.S., but are a serious concern in Australia, Canada, Denmark, Finland, Ireland, Italy, Netherlands, New Zealand, Norway, Spain, Sweden, and the United Kingdom. It also presents data showing much longer waits in other countries than in the United States for both routine health care services and serious ones, such as heart bypass surgery.

Isn't that the same OECD report that said there were no noticable wait times in countries like Japan,Germany and France, the countries any US healthcare system will likely be modeled after?

Anyways, i'm not going to engage in your red herring debate. The fact is that more and more data is coming out saying that the US has waiting times just as comparable. The CMO from Aetnia isn't just pulling this out of his ass because it's good for business.

Don't confuse what the politicians will do and the insurance company will allow in terms of their lobbying dollars to pay off those politicians. Washington isn't the American people on this issue. It hasn't been for along time.

If serious conversation is going to happen- those interested need to start disquishing between what Washington says and does, and what the American people want.

Posted by: akaison | Jul 11, 2007 3:56:04 PM

What ever the data says, lets say they are comparable now. How will it not get much worse by adding 45 million people to the system when last time I checked it takes about 8-11 years to churn out a new doctor after college is complete. Most docs out now are maxxed out and going fast and furious with less and less time to spend per patient.

Posted by: dingo | Jul 11, 2007 3:59:27 PM

I'm sorry, Ezra, but for a self-described "wonk" who is obviously a pretty bright, inquisitive guy, you're getting to be way too cute. This post is all too typical. I don't believe that you honestly believe that waiting times in the U.S. are no better than in other industrialized countries. Relying on a couple of atypical studies is beneath you.

And when you write things that you know are not true, you know what that makes you.

Posted by: ostap | Jul 11, 2007 4:03:11 PM

and now the award for more bs- ostap- since it's the rights claim that the sole reason at this point we should keep this clunker of a system is that it has better wait times- not better results, just wait times- who should prove that it does or doesn't? I am sorry that the study isn't sufficient for you- but you would think if you were right about wait times it shouldn't even be a close call. Me thinks your problem is like most who bullshit is that you don't like what hte number say.

Posted by: akaison | Jul 11, 2007 4:09:18 PM

How about the issue of bankruptcy? My mother was diagnosed with osteoporosis by her doctor at a medical practice that announced bankruptcy a couple weeks later. To get her medical data and transfer it to a doctor somewhere else, she had to threaten to sue. Turns out the practice hadn't been paying the company that it relied on for data storage. She was given a set of keys and a pass code to a filing cabinet and instructed to enter an unheated, unlit warehouse with a flashlight to get her files herself. The company wasn't about to spend a dime more than legally required on a client with past due bills.

Her treatment was significantly delayed due to the bankruptcy. I can't imagine this scenario in a public system.

Posted by: tmchale | Jul 11, 2007 4:10:48 PM

by the way-w hat did I tell you- denial and red herrings. thats all that got left.

Posted by: akaison | Jul 11, 2007 4:11:03 PM

I don't believe that you honestly believe that waiting times in the U.S. are no better than in other industrialized countries. Relying on a couple of atypical studies is beneath you.

Yeah, shame on you, Ezra, for coming to conclusions that contradict my preconceived notions of American healthcare supremacy. Also, shame on you for relying on radical left-wing biased sources like Business Week and that Troy Brennan guy.

Hint: It's where sauerkraut comes from.

New World Market at 21st & Geary? Huh. I never thought about going there for healthcare.

One should note that JasonR is citing "research" from the Canadian equivalent of the American Enterprise Institute as proof that the Canadian healthcare system is bad. It's amazing the results that conservatives can get when they pay for them.

A good poll would be this: Are you for a universal system if you have to wait 30-40% longer for a doctors appointment or test. No matter how you dice it times will go up that is a given. How much? Who knows? Physicians are a finite resource. Their time is maxxed out at present. It like having a Yugo that goes 0-60 in 10 seconds. You cant put 10 clowns in the backseat and expect it to do it again without some serious modifications. Unfortunately those type of modifications take about a decade. There is no guarantee any of our statistics will improve as long as we continue to be the fattest and laziest country in the history of the world.

Posted by: Dingo | Jul 11, 2007 4:22:37 PM

Isn't that the same OECD report that said there were no noticable wait times in countries like Japan,Germany and France, the countries any US healthcare system will likely be modeled after?

Who says it would "likely" be modeled on one of those countries? I see very little discussion of the health care system of Japan, and not much more of Germany's. The ones most often talked about by American proponents of reform are Canada's and Britain's, although few seem to have much enthusiasm for Britain's NHS.

And the French health care system has very serious problems of its own.

Posted by: JasonR | Jul 11, 2007 4:27:18 PM

One should note that JasonR is citing "research" from the Canadian equivalent of the American Enterprise Institute as proof that the Canadian healthcare system is bad.

Yeah, the American Enterprise Institute is hopelessly biased, whereas, say, the Economic Policy Institute (Ezra's favorite source of economic research. Sorry, I mean, "research") is a model of impartiality and balance.

I'm a Californian transplanted to DC, and surprisingly at peace with it. Or at least I was till it started getting colder. Job-wise, I'm the staff writer for The American Prospect. In the past, I've written for the Washington Monthly, the LA Weekly, The LA Times, The New Republic, Slate, The New York Sun, and the Gadflyer. I'm a damn good cook. No, really. Want to know more? E-mail, I'm friendly.